Radiology Coding Alert

Don't code guidance in addition to 49084 either.

Prior to Jan.1, 2012, abdominal paracentesis and peritoneal lavage shared codes -- meaning that you couldn't use codes to distinguish which procedure your physician actually performed. Plus, you needed to know whether your physician was performing an initial service or a subsequent peritoneal procedure -- a fact that was often difficult to ascertain from the encounter note.

CPT® 2012 changes all that by deleting the following codes:

• 49080, Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial
• 49081, ... subsequent.

Those codes have been replaced with the following new codes:

• 49082, Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
• 49083, ... with imaging guidance
• 49084, Peritoneal lavage, including imaging guidance, when performed.

These new codes apply when the physician "treats a patient with accumulated peritoneal fluid or possible internal bleeding," explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

Example: A patient has a confirmed right malignant ovarian tumor (183.0) and has developed malignant ascites (789.51). Due to the patient's immediate discomfort from the ascites in her abdominal cavity, the radiologist performs an abdominal paracentesis. The radiologist uses ultrasound guidance to aid in the aspiration, documents his ultrasound observations, and reports 49083.

Get a Grip on Guidance Rules

The 2011 codes, 49080 and 49081, had a note that "If imaging guidance is performed, see 76942 [Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation], 77012 [Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation]."

Because 2012 codes 49083 and 49084 include imaging guidance you should not report a separate code for related imaging guidance. New parenthetical references following these codes enforce this rule by indicating which guidance codes you should not report, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, a coding and billing company in Bedford, Mass. Specifically, CPT® instructs you not to report 76942 (ultrasonic), 77002 (fluoroscopic), 77012 (computed tomography), or 77021 (magnetic resonance) in addition to 49083 and 49084.